We use these guidelines if you received a work-related injury and are curious about the effect of “Scheduled Loss of Use (SLU) on your great and smaller toes. Then, you could be eligible for a compensation payment determined by the Workers’ Compensation Board’s regulations.
Our SLU report will conclude that you have permanently lost function in the injured body part due to your work-related accident. The determination of impairment is based on New York state Workers’ Compensation guidelines.
Objectives for Determining Toe Impairment
Toes, mainly the great toe, enable gait stability and unilateral stance. In addition, toes provide support when elevating to reach. Therefore, more than one toe may cause a significant overall impact on the foot.
We must objectively assess a patient’s permanent residual physical deficit due to an injury by evaluating history and physical examination and interpreting diagnostic testing.
Permanent Greater and Smaller Toes Impairment Assessment Methods
We evaluate the degree of permanent residual physical deficit when not expecting further healing during maximum medical improvement (MMI). We must determine the MMI based on the clinical treatment course outcome, expertise, and other additional treatment options.
In addition, we will consider the contralateral extremity and expected values when assessing the level of permanent residual physical deficit. Typically, one year from the injury or the last surgery is required to determine the time from the injury to MMI.
We must not assess the permanent residual physical deficit severity of the mechanism of injury. Instead, we use the time of MMI, including physical bone, muscle, cartilage, tendon, nerve, blood vessel, or other tissue damage.
Maximum Rating of a Body Part
We use the Guidelines to evaluate permanent residual physical deficit of the greater and smaller toes. We must determine single toe loss or impairment based on the greater or smaller toes alone and not as part of the foot. The total impairment must not exceed 100% of the following major body members when evaluating multiple toe impairments in one comprehensive rating.
The Great Toe
The great toe is composed of two major joints:
- MTP: metatarsophalangeal joint
- IP: interphalangeal joint
Figure: Great Toe
Calculating Loss of Use of the Great Toe
Table: Great Toe: Percent Loss of Use of the Great Toe
We determine the deficit extent by selecting one from the following table. First, the maximum loss of the use of the great toe must not exceed ankylosis. Then, we proportionally adjust the schedule loss of use percentages for the range of motion values.
Smaller Toes (Second, Third, Fourth & Fifth)
Figure: Smaller Toes
Calculating Loss of Use of Smaller Toes
Table Smaller Toes: Percent Loss of Use of Smaller Toes
We determine the deficit extent by adding A + B + C. The maximum loss of the use of a smaller toe must not exceed ankylosis. Then, we proportionally adjust the schedule loss of use percentages for the range of motion values.
Note:
Marked, moderate, and mild (DIP, PIP, MTP) are given the same schedule values as the DIP, PIP, and MCP finger joints.
* We use the lower value for one deficit (flexion/extension) and the higher value for both deficits.
Table 9.5(A)(2) Percent Loss of Use of the Toe: Amputations, Ankylosis, or Loss of Active Motion
Toe Amputations and Loading
- We use a 50% loss of the use of the great toe for great toe amputation at the distal phalanx/interphalangeal joint.
- We utilize a 50% loss of the great toe for great toe amputation at a significant distal phalanx portion.
- We evaluate a 100% loss of the great toe for great toe amputation at the metatarsophalangeal joint or proximal phalanx.
- We will allow a 50% load and convert to a foot schedule for at least two amputated toes.
- We use a 100% load for each affected toe if bone loss is present through the metatarsals.
- We utilize a 25% load for deficits of at least three toes without bone loss.
- We will load at 100% and convert to a foot scheduled for amputation of the five metatarsals.
Note:
Refer to the loading instructions in Chapter 2.
Please refer to your state’s Workers’ Compensation Board website or speak with your Workers’ Compensation attorney for more information.
